# Are there any medical guidelines for using feeding tubes on depressed patients? **URL:** \ **Category:** Factual Questions\ **Created:** [September 3, 2021, 6:27pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059 "2021-09-03T18:27:13Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![aceplace57](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aceplace57/32/3500_2.png) [@aceplace57](https://boards.straightdope.com/u/aceplace57)\ **Post date:** [September 3, 2021, 6:27pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/1 "2021-09-03T18:27:13Z")
I have a relative in a long term care facility. Her roommate has stopped eating and slowly starving themselves to death. She’s stopped talking, watching TV, or interacting with the staff. She’s already been assigned to hospice. Doctors could intervene with Antidepressant medications and a feeding tube. Are there any guidelines doctors must follow? Is age a factor? Would they intervene if the person was 25 instead of 80? It doesn’t appear that a DNR applies. A feeding tube isn’t a advanced means of life support. It seems like there should be strict guidelines that cover this situation. > [@](#): > > In the U.S., CPR and advanced cardiac life support (ACLS) will not be performed if a valid written “DNR” order is present. Although state laws vary, it is typical for emergency medical services personnel who are presented with a valid DNR form, signed by your doctor, or who identify a standard DNR bracelet on you, to comply with the DNR order. > **[DNR Guidelines for Medical ID Wearers | American Medical ID](https://www.americanmedical-id.com/dnr)** > > The DNR request is usually made by the patient or health care power of attorney and allows the medical teams taking care of them to respect their wishes. Learn what DNR information you should engrave on your medical ID ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [September 3, 2021, 6:57pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/2 "2021-09-03T18:57:58Z")
I’m pretty sure the guideline is that competent patients can make their own medical decisions, and incompetent persons usually have a decision-maker that either they have chosen or who was appointed by a court. And in my state, the person I choose as my health care proxy can make decisions regarding artificial nutrition/hydration as long as they know what my wishes are- and there’s space on the form to detail my wishes. It’s completely separate from a DNR order. ---
**Author:** ![md-2000](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@md-2000](https://boards.straightdope.com/u/md-2000)\ **Post date:** [September 3, 2021, 7:19pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/3 "2021-09-03T19:19:29Z")
AFAIK, my father made no decisions about DNR and end of life care. He was 92 but quite aware until the last few days. However, when things became serious (and also before an operation) the doctors consulted next of kin who were actively participating in his care (myself and my nephew) about whether we would authorize “extraordinary measures”. When it came down to it, I did not see antibiotics or IV fluids as “extraordinary measures”, but no tubes down the throat please. In the end they had to discontinue IV fluids because the result was his lungs filling with water… which they mentioned to us and I deferred to their professional judgement. Not sure what the rules are/were, but it was professionalism and simple courtesy to ask the next of kin what they wanted in lieu of a response from the patient. My attitude to these sorts of things is - will it help cure? Are you doing this to get through a crisis, or will it be a permanent thing? Prolonging life so someone can stare at the ceiling with tubes in their throat for a few days or weeks does not sound like it’s worth it. But in a situation where someone can come out the other end with a decent quality of life for a time - probably worth it. I’m not doctor or lawyer, don’t know medical - but it seems to me DNR is for people who have encountered a close-to-end-of-life situation. If someone is depressed and not eating, I would imagine they would have to be pretty far gone, close to death to argue a DNR should kick in. How depressed do you have to be before a judge declares the person incompetent to express their DNR wishes? Can a judge order to override a DNR made while the person was competent? ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 3, 2021, 8:23pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/4 "2021-09-03T20:23:24Z")
I consider a feeding tube to be an advanced life support measure. If it needs to stay in for any length of time, it’ll need to be placed surgically thru an incision in the abdomen. And even an NG feeding tube is an invasive procedure. To place one, the patient (or whoever holds activated medical power of attorney IF applicable) would need to consent. If the patient didn’t want it & was competent it’d take a LOT of other considerations for me to even think of overriding their decision with a court order. I’ve done so, but that was for patients who were in the custody of the state, and not suffering from severe disorders, and were refusing nutrition as a means of threatening suicide/manipulating the system. THEN the state’s interest can outweigh the patient’s choice. But a judge must decide that. Old lady, sick and bedridden in a nursing home with no real hope of improvement, but only slow continued deterioration who’s refusing to eat? Hospice care is a fine idea. Of course, one must take care to address treatable disorders that would improve their life if ameliorated, but those treatments generally shouldn’t be forced either. ---
**Author:** ![DocCathode](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doccathode/32/18773_2.png) [@DocCathode](https://boards.straightdope.com/u/DocCathode)\ **Post date:** [September 3, 2021, 9:51pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/5 "2021-09-03T21:51:46Z")
Speaking a patient diagnosed with severe depression, I fear a slippery slope. Within living memory, patients were sterilized and lobotomized against their will. I also agree with **MD-2000** If we’re saving a life so it can go on being sucky and meaningless, we have to wonder why we’re doing it. There are certainly times when we should intervene against somebody’s will. But with great power must come great responsibility. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [September 3, 2021, 11:03pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/6 "2021-09-03T23:03:34Z")
This patient is in hospice. She isn’t eating because she’s dying, and I’m sure the HCPs who are looking after her know what they are doing. This kind of thing is very common, and it is NOT the same as euthanasia, assisted suicide, etc. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [September 3, 2021, 11:15pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/7 "2021-09-03T23:15:47Z")
I have Parkinsons and Alzheimers in the family line, and have decided that if I have a firm diagnosis of dementia, I do want to end it before I end up a vegetable in a wheelchair like my Mom, being tended like she was a philodendron. I also know that when my spinal stenosis renders me basically dead from the waist down, I want a urostomy so I don’t sit around in a wet diaper while I try to roll my ass to a toilet or wait for someone to come change me. I already have the stoma for my stage 3 colorectal cancer being cut out, and it has improved my quality of life by a hundred percent [no more trying to get to a toilet with raging diarrhea and not making it.] I figure that being able to empty a pee bag as easily as I can deal with a poop bag will make being stuck in a chair comfortable. PSA - Get your regular colonoscopy and if ANYTHING in your toilet habits change at all, see the damned doctor as soon as possible. [mine went from nothing to stage 3 in some level of time under 5 years - put it down to the insane amount of stress pumping cortisol into my system?] ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [September 4, 2021, 2:12am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/8 "2021-09-04T02:12:21Z")
> [@aceplace57](#): > > Doctors could intervene with Antidepressant medications Feeding tubes are invasive. But anti-depressant medications? That’s a completely different ball game. Facilites can’t give medication without informed consent – but also can’t withhold care without informed consent. “We let patients get so depressed that they die” isn’t a good look for a care facility. Depression is marked by poor judgement – lack of capacity to make informed consent. If the facility has a patient they think has poor judgement, someone should have or acquire guardianship. Very messy, but so is the alternative. ---
**Author:** ![aceplace57](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aceplace57/32/3500_2.png) [@aceplace57](https://boards.straightdope.com/u/aceplace57)\ **Post date:** [September 4, 2021, 2:54am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/9 "2021-09-04T02:54:52Z")
I wasn’t sure what options could be used to prevent a death. I understand prolonging a life isn’t always desirable. It bothers me seeing someone reject food. I try not to visit my relative at mealtime. Her roommate won’t be alive for much longer. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [September 4, 2021, 3:14am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/10 "2021-09-04T03:14:25Z")
My by-then highly demented relative was given a feeding tube against her directive by a doctor who decided it was his decision, not hers. He refused to remove the tube, claiming it would be illegal. My relative lived another two years as an unconscious shell, using up a huge amount of money for her “care.” You can damn well believe that my advanced directive explicitly excludes artificial feeding under specifically identified circumstances. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [September 4, 2021, 3:26am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/11 "2021-09-04T03:26:45Z")
I’m not saying anti-depressants have no use - but they may not have much use in a patient who is in a long-term care facility receiving hospice care. Hospice care generally means the patient is expected to live six months or less, and **aceplace** doesn’t mention and probably doesn’t know any other details about her medical condition or treatment- but there are certainly situations in which depression does not mean that a person has lost decision making capacity , even the capacity to refuse to take anti-depressants. I mean, it’s entirely possible that the woman was offered anti-depressants and refused and was evaluated and found to be capable of making that decision. Decision making capacity is not generally determined simply by which decision a person makes - otherwise, nearly everyone who refuses treatment against medical advice would be found to lack decision making capacity. ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [September 4, 2021, 10:46am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/12 "2021-09-04T10:46:16Z")
> [@aceplace57](#): > > …She’s already been assigned to hospice…It doesn’t appear that a DNR applies… I used to work in a hospice. Unless things have changed, one of the requirements for admission was that a DNR order be in place. And we never, _ever_ used a feeding tube. Or an IV, for that matter. This was quite a while ago, and even then likely varied from state to state. mmm ---
**Author:** ![thorny\_locust](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thorny_locust/32/431_2.png) [@thorny\_locust](https://boards.straightdope.com/u/thorny_locust)\ **Post date:** [September 4, 2021, 11:10am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/13 "2021-09-04T11:10:33Z")
> [@aceplace57](#): > > It bothers me seeing someone reject food. The person herself might not be bothered by it, and might indeed be bothered by eating. She’s not necessarily refusing to eat despite hunger because of depression. Her body may be shutting down and no longer able to properly process food. It’s very common for those near the end of life, whether humans or other creatures, to stop eating. It’s not at all like a hunger strike in a person otherwise quite capable of eating. ---
**Author:** ![FlikTheBlue](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fliktheblue/32/10972_2.png) [@FlikTheBlue](https://boards.straightdope.com/u/FlikTheBlue)\ **Post date:** [September 4, 2021, 11:55am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/14 "2021-09-04T11:55:27Z")
> [@Mean\_Mr.Mustard](#): > > I used to work in a hospice. Unless things have changed, one of the requirements for admission was that a DNR order be in place. > > And we never, _ever_ used a feeding tube. Or an IV, for that matter. > > This was quite a while ago, and even then likely varied from state to state. > > mmm Those things are more common than not, but not true 100% of the time. I have a few hospice patients without a DNR. Yes, that combination of circumstances does tend to get complicated. I’ve never ordered a new feeding tube for someone already on hospice, but if they were using one already (a PEG tube, not an NG tube) then I see no reason not to keep using after they start hospice. IV fluids, depending on the situation, could also be considered a comfort measure. ETA: As to the OP, it may not be just depression causing that patient to refuse food. In the end stages of dementia, people start to “forget” the basics such as forgetting how to be hungry, forgetting how to stay awake, forgetting how to swallow, forgetting how to breathe, etc. There’s now way of fixing those things, and hospice is appropriate in those situations. ---
**Author:** ![aceplace57](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aceplace57/32/3500_2.png) [@aceplace57](https://boards.straightdope.com/u/aceplace57)\ **Post date:** [September 4, 2021, 1:16pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/15 "2021-09-04T13:16:17Z")
> [@thorny\_locust](#): > > It’s very common for those near the end of life, whether humans or other creatures, to stop eating. It’s not at all like a hunger strike in a person otherwise quite capable of eating. Thank you for that information. It makes me feel a lot better about the situation. My relative has been very concerned about her roommate’s rapid decline in health. It strikes a little too close to home. No one gets out of this world alive. ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [September 4, 2021, 3:30pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/16 "2021-09-04T15:30:24Z")
My wife had a friend whose quality of life had deteriorated to such a degree that she simply decided for herself to stop eating. She explained this to her husband and son and they accepted her decision. She died within a week or two. ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [September 4, 2021, 5:00pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/17 "2021-09-04T17:00:04Z")
> [@thorny\_locust](#): > > …It’s very common for those near the end of life, whether humans or other creatures, to stop eating. It’s not at all like a hunger strike in a person otherwise quite capable of eating. Now that I think of it, in our hospice we used prednisone as a treatment for stimulating the appetite. If a patient reached a certain dose (100mg/day, I believe) and still had no appetite, that was considered an ominous sign. mmm ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [September 4, 2021, 10:45pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/18 "2021-09-04T22:45:46Z")
> [@Mean\_Mr.Mustard](#): > > prednisone … which sometimes causes depression. If she’s depressed because she’s being treated (unsuccessfully) for dying, perhaps the prednisone should be withdrawn, but that’s a complex decision: it might accelerate death. If she’s dying because she’s depressed, she’ll probably take any anti-depressant prescribed for her, but prescribing anti-depressants for a person who is too depressed to consent or object is a complex decision. If she’s depressed because she’s dying, she should be offered anti-depressants, which may not work, but that’s a complex decision: she may already be on a half-dozen other drugs, each of which may have an interaction. Being depressed is a terrible condition. When did you last hear of a person killing themselves because they lost an arm or a leg? Yet people kill themselves because they are depressed. To use the common phrase: that’s because it’s worst than loosing an arm or a leg. But treatment is not simple or universally effective: people are still killing themselves, even people who are under treatment. I hate to hear about / read about somebody dying with depression. It strikes too many personal chords. I also don’t see why a depressed person should be tortured by being forced to live in torture: nobody has ever explained that to my satisfaction. ---
**Author:** ![thorny\_locust](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thorny_locust/32/431_2.png) [@thorny\_locust](https://boards.straightdope.com/u/thorny_locust)\ **Post date:** [September 4, 2021, 11:27pm UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/19 "2021-09-04T23:27:30Z")
Do we know for sure whether she’s depressed at all? Maybe she’s withdrawing from food and interactions because she’s dying, and no longer has either any physical interest in eating or enough energy for paying attention to the TV or the staff. ---
**Author:** ![aceplace57](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aceplace57/32/3500_2.png) [@aceplace57](https://boards.straightdope.com/u/aceplace57)\ **Post date:** [September 5, 2021, 12:23am UTC](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059/20 "2021-09-05T00:23:01Z")
I don’t have any specific medical information. I visit my relative a few times a month and noticed the roommate’s declining health. She seemed much better last spring. A nurse came in and said she was from hospice. I wasn’t surprised. [Next page](https://boards.straightdope.com/t/are-there-any-medical-guidelines-for-using-feeding-tubes-on-depressed-patients/950059.md?page=2)